CAD/CAM international No. 1, 2012
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[1] =>
CAD0112_01_Title
CAD0112_01_Title 22.02.12 10:11 Seite 1
issn 1616-7390
Vol. 3 • Issue 1/2012
CAD/CAM
digital dentistr y
international magazine of
1
2012
| special
New concepts
in computer-guided implantology
| opinion
CBCT and implants:
A career-altering experience
| industry report
Lithium disilicate,
the restorative material of multiple options
[2] =>
CAD0112_01_Title
Experience peace of mind.
Join the brand that reaches
over 200,000 clinicians.
Rely on consistent precision
of fit and ready-to-use
products.
Receive direct local support.
NobelProcera Implant Bridge
It’s called NobelProcera. A complete system with the
power to give you peace of mind working with one, secure,
full-service provider. Its CAD/CAM system lets you scan,
design and send your production orders to us for qualityassured centralized manufacturing. Take comfort in having
more than just products. Find value in a solid relationship
with one partner that focuses on you with customized local
support. Choose the predictability of a premium brand and
enjoy a wide range of certified materials and products with
guaranteed satisfaction. When you par tner with Nobel
Biocare, you gain access to over 25 years of CAD/CAM
experience, the latest digital technology and precision milling
to realize every prosthetic possibility for your customers.
Their smile, your skill, our solutions.
Visit nobelbiocare.com/dental
© Nobel Biocare Services AG, 2011. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of
Nobel Biocare. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.
NP CAD Impl Bridge LAB A4 CADCAM.indd 1
2012-03-26 15.46
[3] =>
CAD0112_01_Title
CAD0112_03_Editorial 26.03.12 14:48 Seite 1
editorial _ CAD/CAM
I
Dear Reader,
_CAD/CAM has revolutionised engineering and manufacture since the 1950s. In the
1980s, such processes were progressively applied and integrated in the field of dentistry. It is
no surprise that along with the technological milestones attained within the last decades,
computerised dentistry and dental CAD/CAM technology have developed at a rapid rate. The
2011 International Dental Show in Cologne highlighted the unprecedented improvements
in CAD/CAM, with exhibitors and attendees indicating that a growing number of manufacturers are joining the market.
Dr Dobrina Mollova
The fast growth in CAD/CAM dentistry alongside new technology, materials and equipment
has seen an increasingly rapid integration into both dental offices and laboratories. Without
a doubt, digital technology is pivotal for the operational viability of every dental practice and
laboratory. Are we prepared to keep up to speed with this growing industry? Can we implement
this pool of information and technology in our practices without the proper expertise?
As with all new technologies, education and training are essential. The development rate
of computerised technologies is not in sync with the level of training most dental professionals have attained. Evidently, with time, we will have to start implementing such technologies to remain up to date with standards and practices within the field. Companies and
professionals specialised in digital dentistry place a great deal of effort and enthusiasm into
training dental clinicians, technicians and dental assistants in basic and advanced techniques
and procedures. Is this sufficient for the fast-paced and challenging reality they face on a
day-to-day basis in their career? Every day, there are questions and uncertainties about
approaching diagnostics, treatment plans and the selection of the proper material to obtain
the desired outcome. Last but not least, the investment costs and the all-important return on
investment have to be taken into consideration.
Since CAPP (Center for Advanced Professional Practices) started out in 2006 with the first
CAD/CAM & Computerized Dentistry International Conference in Dubai, we have experienced
a steady increase in the number of the events we hold and the number of participants and
visitors. This year, the CAD/CAM & Computerized Dentistry International Conference will have
spring and autumn editions: the sixth conference will take place in Dubai from 3 to 4 May
2012 and the seventh conference will be held in Singapore from 6 to 7 October 2012. This will
be the first Asia-Pacific edition of the meeting. We would like to warmly invite all dental
professionals to join us for these events. We are very excited to organise events focused
entirely on computerised dentistry, aiming to build important bridges between our dental
team, dentists, dental technicians and the industry.
In 2012, the CAD/CAM magazine will serve as a platform for education and information
exchange with a new rubric—digital platforms. Dental schools, societies, associations and
companies are invited to announce their course schedules here. More information about this
exciting project is available inside this issue.
Yours faithfully,
Dr Dobrina Mollova
Managing Director of CAPP
Dubai, UAE
CAD/CAM
1_ 2012
I 03
[4] =>
CAD0112_01_Title
CAD0112_04_Content 26.03.12 14:49 Seite 1
I content _ CAD/CAM
I editorial
03
I industry news
Dear Reader
34
| Dr Dobrina Mollova, Guest Editor
06
New concepts in computer-guided implantology
(Part I)
I opinion
I digital platforms
38
Course calendar
I meetings
CBCT and implants: A career-altering experience
| Dr Steven A. Guttenberg
40
International Events
I about the publisher
I feature
18
Introducing Lava Ultimate CAD/CAM Restorative
| 3M ESPE
| Dr Gian Luigi Telara
16
| Sirona
36
I special
CEREC announces its next anniversary
An interview with Gilles Pierson, CEO of the
Acteon Group
41
42
| submission guidelines
| imprint
I industry report
issn 1616-7390
22
Full-arch reconstruction of the edentulous maxilla
with the CAMLOG Guide System
Vol. 3 • Issue 1/2012
CAD/CAM
digital dentistry
international magazine of
1
2012
| Dr Claudio Cacaci
| special
New concepts
in computer-guided implantology
26
Lithium disilicate, the restorative material
of multiple options
| Lee Culp & Prof Edward A. McLaren
04 I CAD/CAM
1_ 2012
| opinion
CBCT and implants:
A career-altering experience
| industry report
Lithium disilicate,
the restorative material of multiple options
Cover image courtesy of Renishaw.
A Renishaw 98D zirconia billet with frameworks already milled, loaded in a Renishaw incise milling machine.
[5] =>
CAD0112_01_Title
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Planmeca Oy
Asentajankatu 6, 00880 Helsinki, Finland
tel. +358 20 7795 500, fax +358 20 7795 555
sales@planmeca.com
[6] =>
CAD0112_01_Title
CAD0112_06-14_Telara 26.03.12 14:49 Seite 1
I special _ guided implantology
New concepts
in computer-guided
implantology
Part I: Thread timing and implant phase
Author_Dr Gian Luigi Telara, Italy
Fig. 1c
Fig. 1a
Fig. 1b
Fig. 1a_Components of the
bottle-neck device.
Fig. 1b_Embedded sleeve.
Fig. 1c_Ostetomic sleeve.
Fig. 1d_Modified extender to fit the
osteotomy sleeve—any hand-free
surgical kit will work.
_Accuracy in guided implantology is an issue.
The ability to perform implant placement both
safely and correctly, in order to load a pre-surgical
CAD/CAM bar or cementable metal final framework
prosthesis and to digitise the entire procedure, is
widely researched. Accuracy is a value also in a classical II-stage protocol and respecting hard and soft
tissues for long-term implant site stability.
Fig. 1e_Bottle-neck.
Figs. 1f–h_Bottle-neck created.
Fig. 1i_Assembly while being
screwed.
Fig. 1e
There is an ongoing debate amongst clinicians regarding which is the best available system.
Vercruyssen summarises this debate.1 The article
reviews only some of the published articles on this
topic. All of these articles emphasise the error margins and that they can be considered clinically more
or less acceptable, and determine accuracy in implant placement by means of superimposition.
Fig. 1f
06 I CAD/CAM
1_ 2012
Fig. 1g
Fig. 1d
In mathematical terms, “precision” means the
repeatability of a measurement, and “accuracy” refers to the correspondence of this measurement to
the truth. In our field, accuracy has been considered
the correspondence of the placed implant to the
planning.
Fortin defines “accuracy” as an ideal, at present
somewhat impractical, when considering a definitive prosthesis for immediate loading, with the
present systems only offering predictable results
(and as such only long-term reinforced provisionals
will be available), but does not quantify a threshold.2
According to Di Giacomo, at present a post-operative impression appears to be always necessary for
immediate loading with a definitive prosthesis.3
Guided implantology is far better than a free-hand
Fig. 1h
Fig. 1i
[7] =>
CAD0112_01_Title
CAD0112_06-14_Telara 26.03.12 14:49 Seite 2
special _ guided implantology
I
approach, however. A guard-rail-like guide is certainly better than nothing.
Many systems are available today, and from a
theoretical perspective they have been categorised
into semi-active and passive systems. The systems
in the first category, whatever the technique used
to make the surgical guide (STL or stone surgery),
have metal smooth guiding sleeves, which the implant and the implant-driver must pass through,
and the second systems, also called navigation systems, do not have any metal sleeves and the surgeon
is guided by the monitor. In this category, the surgical handpiece is indexed to spatial markers inside
a surgical guide that is inserted into the patient’s
mouth, but not in the surgical area. These spatial coordinates are viewed by an infra-red system, which
transfers data to the computer, allowing the clinician to follow the surgical steps on the monitor.
Alarm lights and sounds will warn the clinician of
deviations from the desired position.
Fig. 2
I propose a new definition of a passive system:
a passive system must allow any operators (i.e.
it must be operator independent) to achieve the
same, repeatable results at an acceptable inaccuracy threshold.4 The accepted inaccuracy must
allow clinicians to obtain a good metal-to-metal
fit without placing tension on the implants. This
“to what extent” predictability can determine the
reliability of treatment. In fact, in fixed prostheses
on natural teeth, passivity (at an acceptable gap) is
about 40 to 50 µ in the arch; the same values could
be considered acceptable for prostheses on implants. According to this definition, none of the
systems on the market has replicable results, and
have metal or virtual smooth sleeves. They must
thus be considered metal or virtual smooth semiactive systems.
I have developed a new device according to the
mathematical concepts of thread timing and implant phase, which can be applied to the implant
movement while being screwed, thus allowing clinicians passivity during implant placement. In the
future, owing to the predictability of implant placement, the proposed device could be fundamental to
achieving the desired goals in computer-guided
implantology.
_Materials and methods
The implants were placed using the bottle-necklike device, which begins implant rotation before it
can touch the bone, thereby avoiding bone interference with implant movement owing to bone density
gradients (“bone guidance”). The prototype of the
device (Fig. 1a) consists of:
Fig. 3a
Fig. 3b
_an internally threaded sleeve (“embedded sleeve”,
with a “helical gear” feature at its top that is useful
during implant placement; Fig. 1b);
_an externally threaded sleeve (“osteotomy sleeve”),
which has to be inserted into the embedded sleeve
and serves as a regular sleeve for the osteotomy
drills (because it is internally smooth; Fig. 1c);
_a modified extender for drills (Fig. 1d);
_an externally threaded sleeve, longer than the
osteotomy sleeve, that acts as a “bottle-neck” and
Fig. 2_Surgery planning
for the STL case.
Figs. 3a & b_Surgery planning
for the stone case.
CAD/CAM
1_ 2012
I 07
[8] =>
CAD0112_01_Title
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I special _ guided implantology
Fig. 4
Fig. 5
Fig. 4_Analogues in the STL model.
Figs. 5 & 6_Surgical guide created
for stone surgery.
is screwed into it (Fig. 1e); and
_the “bottle-plug”, which is screwed onto the bottle-neck (Figs. 1f–h).
Figs. 7a & b_Assembly.
Fig. 7c_Assembly in the
stone-based surgical guide.
Fig. 7d_Assembly in the
STL-based surgical guide.
Fig. 8a_Surgical guide in the mouth.
Fig. 8b_Surgical guide in the mouth,
showing the helical gear in particular.
For the osteotomy, I used a regular surgical kit,
not a dedicated one to precision, just modifying a
plain extender to fit any osteotomy surgical kits
(general and not guided surgical kits). The extender
should match up with the sleeve before the drill
touches the bone. The prototype was realised with
no endo-stop features in the extender; only lines
indicate depth.
Fig. 7a
Fig. 6
The bottom end of the bottle-plug is provided
with a helical gear (to match up with the corresponding embedded sleeve’s helical gear; Fig. 1i).
The bottle-plug in the prototype device consists of
two components, the cylindrical screwed part and
the lid, and they are fastened together with a joint.
The lid is integrated into the implant mounting component; thus, while the bottle-plug is being screwed
onto the neck, the implant mount is entering inside
the bottle-neck, forcing the implant downwards.
The implant mount has a hollow to allow for an
implant fastening screw (the same as used to fix
implants and abutments, just longer, to allow for
minimal screwdriver length, when it is necessary to
unfasten the components at the end). The mount
also has a gauge for a wrench at its top (but it can
work for a handpiece driver as well). Once implant
placement has been carried out, the mount can be
unscrewed from the implant and vertically unfastened from the bottle-plug. At this point, the surgical guide can be removed easily, with no risk of hex
undercuts.
Fig. 7b
The device must resist the vertical dislodging
torque created when screwing the implant into the
bone. A screwed bottle-neck performs well for this
purpose and the lid must be fastened to the vertical
part of the bottle-plug.
Fig. 7c
Fig. 7d
Fig. 8a
Fig. 8b
08 I CAD/CAM
1_ 2012
SimPlant Pro Crystal (Materialise Dental) was
used only to plan the implant position (Figs. 2–3a
& b), but instead of using a surgical guide, a STL digital cast with analogue implant holes for placing
analogues was used in the first case reported (Fig. 4).
A plain stone model with a (presumably) correct
analogue position was used for the second case
reported (Fig. 5). In both cases, the analogues were,
screwed to the device, and then the device was
secured to a bite-like thing (using plain relining resin
for the provisionals) to obtain a surgical guide (no
surgical guide fixation to the bone was considered;
Fig. 6).
No guided tapping drill was used. This is something that should be considered, especially in high
[9] =>
CAD0112_01_Title
CAD0112_06-14_Telara 26.03.12 14:49 Seite 4
special _ guided implantology
Fig. 9a
density bone. It could imitate the implant, with
sharp threads and narrow body, to be screwed to
the bottle-plug, or a bottle-plug dedicated to the
tapping step, with the tapping part integral to the
bottle-plug itself.
In both clinical cases, the device was assembled
chairside to allow for minimal vertical clearance
(Figs. 7a–d). A base-plate resin was then used to
create jigs to check accuracy between the models
and the mouth.
_Results
The case results were satisfactory. The device
was easy to use (Figs. 8a & b) and jig correspondence
between the abutments screwed on the analogue
models and the clinical implant positions was obtained.
For the STL case, four abutments were modelled
on the STL model, the resin jig was created directly
in the mouth, and then its correspondence to the
same abutments was checked on the STL model
(Figs. 9a–c). For the stone case, a transfer was
screwed onto the analogue, the resin jig was created, and then its correspondence was clinically
checked (Figs. 10a & b).
_Discussion
The present systems do not offer sufficient and
reliable accuracy because they do not consider the
concepts of thread timing and implant phase. Their
weak point is the smooth sleeve (whether metal
or virtual), which does not have any control over
the mechanics of a screw, which an implant is.
Shooting a bullet makes sense, but shooting a
screw does NOT.
I
Fig. 9b
in the arch will be correct only if the implant mount
does not ever touch the sleeve during the process,
but when the dentist is working there will always
be contact, which will results in an error in B-L and
M-V position. This is what I call the “position paradox effect” of a guiding smooth sleeve (similar to
a guard-rail).
Fig. 9c
Figs. 9a & b_Jig created in
the mouth for the STL case.
Fig. 9c_Jig verified against
the model in the STL case.
Since the sleeve has a top and a bottom plane,
this paradox effect is reproduced in both these two
planes, and an axis deviation is a natural consequence (what I call the “axis paradox effect of
a smooth sleeve”). The gap affects position and axis:
these parameters go hand in hand. Depending on
the gap entity, it is possible to calculate the implant
apex twisting entity, using simple proportionality
(Fig. 11a). At a 20 mm depth from the top of the
sleeve (approximately 13 mm below the ridge), the
linear deviation will be 0.8 mm (1.6 mm on the
diameter that is the possible implant apex twisting
entity). Trigonometry is an easy way to calculate
the deviation angle of the implant axis (sine/cosine
and tan/cot rules). If the gap is 0.1 mm (0.2 on the
diameter), the axis deviation will be a deviation of
2° 20' (Figs. 11b–d).
Tapered implants can engage bone at an even
greater angle, particularly if the driver is conical at
its first part. Consequently, it will work only at the
end of the implant placement phase. According to
the previous considerations, I suggest that it does
not work efficiently. This cone-shaped driver limits
too large an insertion torque because it may be damaging; however, the larger the axis deviation, the
Fig. 10a_Jig created on the stone
model in the stone case.
Fig. 10b_Jig verified in the mouth
in the stone case.
Smooth sleeve-dependent inaccuracy
The first element to be considered is the gap between the implant mount and the sleeve. A twisting implant apex is the natural effect. When the
implant is guided by a smooth sleeve, the position
Fig. 10a
Fig. 10b
CAD/CAM
1_ 2012
I 09
[10] =>
CAD0112_01_Title
CAD0112_06-14_Telara 26.03.12 14:49 Seite 5
I special _ guided implantology
isotropic D2 and D3 bone or by working in sites in
which cortical plates can directionally address implant placement. Excellent results reported could
have been affected by working in low-density bone,
where the marketed system allows for a good axis
and depth, but the drills created a truncated cone
volume devitalised area (depending on the drill
blades’ cutting power and operator’s hand force),
because the low-density trabeculae would be drilled
360° around. The hex would be missed anyway.
Fig. 11a_Mathematical proportion
to calculate the linear radial apex
deviation.
Fig. 11a
Fig. 11b_Calculation of the
trigonometric angle deviation.
Fig. 11b
Fig. 11c_Calculation of the
trigonometric angle deviation
(sine/cosine rule).
Fig. 11c
Fig. 11d_Calculation of the
trigonometric angle deviation
(tan/cot rule).
Fig. 11d
greater the torque perceived by the operator, who
will be given an inaccurate sense of implant stability.
The good results reported in publications could
have been affected by right-handed operators in
10 I CAD/CAM
1_ 2012
The second matter to be considered is bone guidance. Depth and anti-rotational feature orientation
depend on bone morphology and density.
When the implant has started its rotation inside
the bone, it is not possible to change the threading
pattern: while screwing the implant, the platform
will move increasingly deeper downwards to the
bone. Since it is possible to index a hex to a peripheral point along the circumference and a point along
the same circumference can be indexed to the implant thread, the need to change the platform depth
and hex orientation and control the threading pattern (implant phase) will be indicated. Any painted
notch to index the hex and the sleeve is misleading
information and naïve, as it is approximate, that is,
no implant phase, and dependent on notch size,
point of view (parallax) and operator’s visual acuity.
Once the implant has started its rotation, it is not
possible to correct the position by redirecting the
implant, as the apex is inserted into the bone and will
act as a fulcrum. Even if the operator redirects the
implant axis, the implant body will remain displaced
in position (B-L and M-D). Moreover, the redirection
would be done by sight, which is dependent on the
operator’s visual acuity and a parallax error is a
possibility.
The axis deviation introduces another concept:
bone response in terms of bone density and bone
anisotropy. As a matter of fact, on the other side of
the surgical guide, when the implant touches the
bone, with a smooth sleeve it is impossible to predict
when it starts being screwed. The moment the implant starts rotating depends on the bone friction,
depending on the density (HU), and the progression
of the osteotomy and the implant insertion will be
dependent on the HU gradient (anisotropy), which
describes how rapidly the density changes per unit
of length along the three spatial coordinates inside the bone. Unless we use a device able to force
implants in a precise position (referred to as the
surgical guide) along a path engineered according
to a particular mechanics, the bone will determine
the implant threading pattern (bone density for initial screwing, whether or not a crestal bone drill has
[11] =>
CAD0112_01_Title
[12] =>
CAD0112_01_Title
CAD0112_06-14_Telara 26.03.12 14:49 Seite 6
I special _ guided implantology
mined using the naked eye). Depth error, axis deviation and translation in crestal position in the axial
deviation direction will be the results (Figs. 12a–e).
Fig. 12a
Fig. 12b
The likelihood of ideally positioning two implants
is one out of seven billion and 500 million possibilities (just a few million less, if it is any comfort to us).
And this evaluation comes from a 0.1 mm mean deviation and 1° deviation, which implies insufficient
inaccuracy. Fancy what the chances would be of
achieving acceptable accuracy.
Thread timing and implant phase
Fig. 12c
Fig. 12d
Figs. 12a–d_Missed implant
position parameters in the
depth-control systems owing to
congruent triangle considerations
(implant axis deviation and
endo-stop angle).
Figs. 13a & b_Coca-cola screw
plug analogy.
Fig. 14a_Euler’s formula.
been used) and bone density gradient, or anisotropy
for the subsequent axis.
Accepting inaccuracy, manufacturers and researchers have created depth-control systems in
the hope of offering certainty about this parameter
at least, but the gap will be responsible for not only
position and axis deviations, but also depth errors.
In fact, the implant mount endo-stop will match up
with the sleeve at an angle. The first contact will be
beyond the desired depth, and keeping on screwing
the implant will create a great torque with surgical
guide deformation and tension on the bone. The
complete contact will correspond to a deeper implant position than desired. The correct depth may
be halfway (maybe operator dependent and deter-
From a mathematical perspective, it is possible to
describe all implant spatial coordinates concentrated on the platform, where we can summarise
everything, and calculate its trajectory to create
kind of a spiral path, through which it is possible to
start and stop an implant platform along all the
parameters, thus being able to truly speak of implant-guided prosthodontics.
The idea is based on the following: when screwing a coca-cola plug onto the bottle-neck, the final
position will always be the same (Figs. 13a & b). Once
two final positions have been found, two threads
will be inside the plug; once three final positions
have been found, three threads will be present on
the plug. The label written on the plug can be considered to be a hex (or a trilobe). So the hex, that is
the platform, can easily be reproduced in its position
because the thread pattern and hex are indexed to
each other. This means that if we can control the
threading pattern, we can consequently control the
platform position too.
According to this consideration, all the parameters that define the platform position can be controlled. The parameters are the position in the arch
(B-L and M-D), the axis, the depth and the antirotational feature (classically, a hex) orientation.
Fig. 13a
Fig. 13b
Fig. 14a
12 I CAD/CAM
1_ 2012
The mechanical engineering of a screw is quite
different from that of a bullet (smooth sleeve) and
was defined by Archimedes (applications of an
endless screw are still in use today, like the meat
mincer) and by Euler (Swiss mathematician, who
died in St Petersburg more than two centuries ago).
In particular, Euler pointed out that the movement
of a circle (in our field, the implant platform) can be
described with mathematical formulas: a point
along the circumference (in our field the perimetric
projection of a part of the hex) can be projected
along a plane orthogonal to the direction of the
circle movement itself (in our field, the progression
of the platform while the implant is being screwed
in multiplanar reconstructions). The projection will
[13] =>
CAD0112_01_Title
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special _ guided implantology
describe a sine wave (in our field, the sine wave
period can be identified with the implant thread
pitch). With this in mind, I developed the device discussed in this article, which controls the threading
pattern. In mechanical engineering, this is called
thread timing, and the hex position can be defined
as hex timing. For both of them we can speak of
phase control (i.e. we can speak of the phase of the
implant, both for the thread and the hex). Along
this spiral track, the implant can be theoretically
and actually screwed and unscrewed as many
times as we desire (back and forth), and it will always be possible to know the hex position at the
end of the spiral path (final analogue and implant
position; Figs. 14a–c).
Fig. 14b
As a spiral circular motion is transformed into
a pure translation, a threaded device will respect
also position and axis. The information needed to
correctly (position and axis, anti-rotational feature
and depth) place an implant is in its platform and
inside its threads. By creating in the surgical guide
a track along which the implant is screwed before
its contact with the bone, it is logically possible to
start and stop the implant with a final seating with
all the parameters always reproduced. We can thus
decide when to stop the implant during its fall along
this spiral track. The final position will always be the
same, that is repeatable, and operator independent.
The device meets my earlier definition of a passive
system.
The maximum precision possible will be what
manufacturers can effectively offer (a 1/100 mm is
expected to be realistic), which corresponds to the
actual implant placement. With a threaded system,
there is no axial deviation. Therefore, there will only
be a 1/100 mm position deviation (in the arch this
will signify a possible 2/100 mm deviation), no axial
deviation, depth and anti-rotational feature correspondence. This discrepancy is within the limits that
allow the clinician to make a premade final prosthesis and allows for presumably optimal long-term
tissue stability.
Some of the systems available also consider hex
orientation position, but in order to seat the implant
correctly with regard to the anti-rotational feature,
an extra rotation may be needed. Speaking of
“correctly”, at which angle resolution? If the feature
described is in the shape of two points (painted or
alike) to be vertically aligned, what is the point
dimension? What is the eye resolution? Is it possibly
a parallax error? Extra-rotation is an implicit admission of inaccuracy: the depth will not be respected
as well, and the implant platform depth may be a
little above or below the desired position (it depends
on the degree to which the operator is out of phase,
I
Fig. 14c
more or less than 180°). It is easy to realise that, unless all this has been calculated, all attempts to find
the anti-rotational feature position and depth are
only guesswork—a waste of time! Thread timing and
implant phase have not been respected. Forget any
notches on the implant mount and smooth sleeves,
if anti-rotational feature orientation is the goal.
Notches are history in digital guided implantology.
Figs. 14b & c_Euler’s formula
in applied mathematics.
Once we have set a threading pattern, it is possible to set the stop point simply making a helical gear
(a helical gear is realised by contouring the thread
along its 360° run; a vertical step will be present
once we have gone 360° all round) both in the
bottle-neck plug and in the embedded sleeve (the
coordinating feature inside the surgical guide), so
that a vertical stop is realised in the device. When the
two vertical parts match up, we can be certain that
the hex is just where we have engineered it to be.
The device pitch must have the same implant
pitch because differences will lead to bone stripping.
In fact, a difference in implant and mount insertion
speed (i.e. the distance covered in depth every 360°)
and a different wave period (i.e. thread pitch), will
lead to something different from an out of phase
working device; it will lead to bone stripping. In
CAD/CAM
1_ 2012
I 13
[14] =>
CAD0112_01_Title
CAD0112_06-14_Telara 26.03.12 14:50 Seite 8
I special _ guided implantology
particular, a longer mounting period will force the
implant downwards into the bone, with consequent
vertical bone stripping, whereas a shorter mounting
period will force the implant to rotate horizontally, with consequent horizontal bone stripping.
Self-tapping implants should show better torque
control.
Rigidity
The device must be secured to the surgical guide
to resist the rotational torque and vertical torque
always present during the implant rotation inside
the bone.
Crest module
The implant crest module morphology does not
affect this guiding device because the bottle-neck’s
internal diameter is just a little wider than the implant diameter at any point (platform or below the
platform). By the way, additional threads in the crest
module are not important either because, mathematically speaking, they are harmonic waves of the
implant period (thread pitch).
Master cast
The helical gear can easily be oriented vestibularly in the threaded guiding device before pouring
the master model.
Vertical clearance
Fig. 15
Fig. 15_Vertical clearance paragon.
Components and undercuts
In the prototype device, a driver for a ratchet was
used. It was completely redundant because the
ratchet can cooperate directly with a plug-top feature for a ratchet at its top; thus, the driver is something that can be eliminated. Once the assembly has
been fixed to the embedded sleeve, the plug can be
screwed with the fingers, at least until sufficient
torque is found, when a ratchet can be used.
When multiple implants have been planned, in
case of divergent implants, hex undercuts could
prevent the surgical guide from releasing itself from
the bone, once the implants have been placed. In order to resolve this, the device, at least the mounting
part, must be removed from the surgical guide. The
device is thus divided in two components and the lid,
which is integral to the driver, can be unscrewed,
leaving the surgical guide along with all the other
components still fastened to it, but disengaged from
the implants, freely and easily removable.
For single implant placement, the lid is not necessary, because there are no hex undercuts. In this
case, a bottle-plug with one component will be
sufficient.
14 I CAD/CAM
1_ 2012
To make the correct surgical guide, the helical
gear must be engineered in the planning at a multiple pitch distance from the bone, just equalling the
implant length (the implant must start rotating
before it touches the bone to avoid bone guidance).
For instance, the distance will be 9 or 10 mm for
9 or 10 mm long implants with a 1 mm pitch, and the
distance will be a multiple of 0.75 for a 0.75 mm
pitch (9 mm will correspond to 12 implant revolutions and 10.5 mm to 14 revolutions). The average
mouth opening values should be considered. In
case of tapered implants, a short distance can be
considered because the implant apex can enter the
osteotomy hole without being engaged. To reduce
vertical clearance, the device can be pre-assembled,
thus obtaining a working length even shorter than
that of the present systems (Fig. 15). A shorter vertical clearance is possible also with trans-mucosal
implants because the platform results are more
superficial._
Editorial note: This article was first published in Dentale
Implantologie 8, 374–82 (2004), Spitta Verlag. A complete
list of references is available from the publisher.
_contact
Dr Gian Luigi Telara
Studio Odontoiatrico Lippi Telara
Via Vorno, 9/4
55060 Guamo Lucca
Italy
Tel.: +39 0583 947568
lippitelara@gmail.com
CAD/CAM
[15] =>
CAD0112_01_Title
FDI World Dental Federation
Leading the World to Optimal Oral Health
2012 Hong Kong
FDI Annual World Dental Congress
29 August - 1 September 2012
Join us in Hong Kong, world capital of oral health 2012
for a
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Leading the world into a new century of oral health
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[16] =>
CAD0112_01_Title
CAD0112_16-17_Guttenberg 26.03.12 14:50 Seite 1
I opinion _ CBCT
CBCT and implants:
A career-altering experience
Author_ Dr Steven A. Guttenberg, USA
_With all the technologies available to dental
practitioners today, very few can be described as
“career altering”. One of my original reasons for investing in a CBCT scanner was to assist with the
complete evaluation of dental implant sites.
and variation of its form. Currently, I feel that the
scope of data garnered from the CBCT scan is imperative for placing implants safely and correctly for
the best restorative options, and this technology has
indeed altered my approach to dentistry. I continue
to learn from each case that I perform by taking lowradiation, limited, post-operative scans, which help
me become a better surgeon.
The clear, virtual, revolving model of the dentition
captured on the CBCT scan can be rotated, zoomed
in on from any angle and viewed in 360° to assist in
the determination of the implant site, as well as for
the fixture’s proper inclination, length and diameter.
As an added benefit, there are numerous CBCT-compatible, implant-positioning software programmes
available, such as SimPlant (Materialise Dental),
NobelGuide (Nobel Biocare), EasyGuide (Keystone
Dental) and InVivo5 (Anatomage).
Fig. 1
A major concern during implant placement is
the possibility of placing an implant too close to or
penetrating the inferior alveolar nerve canal, likely resulting in injuries such as paraesthesia, anaesthesia
or dysaesthesia. In preparation for the insertion of
fixtures, I wanted to be able to visualise important
anatomic landmarks appropriately, such as the inferior alveolar nerve canal, mental foramen, maxillary
sinus, incisive canal, nasal floor, mylohyoid ridge, and
the location and morphologic variation of adjacent
teeth. The data provided by the scan allows the dentist to locate such structures accurately beforehand,
so that they and potential iatrogenic injuries can be
effectively avoided during surgery.
Obviously, with traditional 2-D radiographs,
I could visualise the general location of these entities
and the approximate height of the alveolus, but a
3-D scan provides more information about the morphology of that ridge—its height and width to within
a hundredth of a millimetre, as well as its angulation
16 I CAD/CAM
1_ 2012
Besides its usefulness for implant patients, my
CBCT has a myriad of other benefits. I use it to gain
information for many of the procedures performed
in my practice: extractions; diagnosis and treatment
of pathology; orthognathic surgery; airway studies;
dental, oral and maxillo-facial trauma; bone grafting;
and evaluation of the paranasal sinuses.
For example, a CB image can show the relationship of a tooth to vital structures such as nerves, the
sinus or other teeth, which could turn an apparently
simple extraction into a complicated one or provide
dentists with information to treat complex extractions more easily. Using preoperative 3-D reconstructions, like those produced by InVivo5, has become indispensable preceding my treatment of jaw
tumours, congenital and developmental deformities,
or maxillo-facial trauma.
In addition to educating me regarding preoperative planning, the CBCT allows patients to understand
my reasons for the treatment that has been suggested better, so they feel more involved in their own
dental health planning decisions. When they must
decide between an implant and other possible treatment options, the 3-D images illustrate and enhance
[17] =>
CAD0112_01_Title
CAD0112_16-17_Guttenberg 26.03.12 14:51 Seite 2
opinion _ CBCT
my verbal explanation. Patients also enjoy the convenience of the in-office CB examination, which
eliminates the need for an extra trip to an imaging
centre and additional appointments at our office.
For my practice, I consider it not only to be the standard of care, but the gold standard for dental practice._
_about the author
Also, as financial considerations and radiation
exposure have become increasingly important concerns, patients appreciate that my CBCT machine
exposes them to considerably less radiation and at
a lower cost than the traditional medical CT scans
taken elsewhere.
From a practice-building perspective, we have
noted that patients are appreciative of in-office CBCT
technology that results in safer and easier treatment,
and they discuss their experience with family and
friends, resulting in increased referrals.
Quite frankly, I cannot even imagine practising oral
and maxillo-facial surgery without my i-CAT, and
I would not want to place an implant without being
aware of all the details that could affect its success or
failure. The CBCT information helps me formulate the
correct diagnosis, whether I am planning an implant,
simple or complex dental procedure, or just consulting.
CAD/CAM
Dr Steven A. Guttenberg, an
oral and maxillo-facial surgeon,
practises in Washington, D.C.,
where he is director of the
Washington Institute for Mouth,
Face, and Jaw Surgery. He is
a diplomate of the American
Board of Oral and Maxillofacial
Surgery and a fellow of the American Association
of Oral and Maxillofacial Surgeons and of the
American College of Oral and Maxillofacial Surgeons,
of which he is a former president. Dr Guttenberg
teaches at the Washington Hospital Center and is
chairperson of its Oral and Maxillofacial Surgery
Residency Training and Education Committee.
He frequently lectures nationally and abroad. His
numerous scientific articles and book chapters have
been published in dental and medical literature.
AD
I would like to subscribe to for € 44 including shipping and VAT for German
customers, € 46 including shipping and VAT for customers outside of Germany, unless a
written cancellation is sent within 14 days of the receipt of the trial subscription. The subscription will be renewed automatically every year until a written cancellation is sent to
OEMUS MEDIA AG, Holbeinstr. 29, 04229 Leipzig, Germany, six weeks prior to the
renewal date.
Reply via Fax +49 341 48474-290 to OEMUS MEDIA AG or per E-mail to
grasse@oemus-media.de
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CAD/CAM 1/12
I
Signature
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Tel.: +49 341 48474-0, Fax: +49 341 48474-290, E-Mail: grasse@oemus-media.de
[18] =>
CAD0112_01_Title
CAD0112_18-20_Acteon 26.03.12 14:51 Seite 1
I feature _ interview
“Our growth is
definitely driven by
innovation and quality”
An interview with Gilles Pierson, CEO of the Acteon Group
_During the 2011 conference of the Association Dentaire Française (ADF) in Paris, Dental
Tribune International spoke with Gilles Pierson,
CEO of the Acteon Group, about the company’s
history, new products and future strategies.
Gilles Pierson, CEO of the Acteon
Group, and Matthias Diessner,
Account Manager, DTI.
18 I CAD/CAM
1_ 2012
_CAD/CAM: Your business units Satelec,
Pierre Rolland and Sopro were unified under the
Acteon Group in 2003, followed by your Italian
business unit, De Götzen, which joined the group
in 2006. At IDS Cologne 2011, you introduced
your new corporate identity and the new Acteon
logo. What was the main reason for this rebranding?
The change in the group’s name is due to
the fact that at the very beginning in 1980,
Satelec existed on its own. Pierre Rolland merged
with Satelec in 1985 to become Satelec–Pierre
Rolland. After 1995, we decided to grow the
company through acquisitions, so we acquired
different companies like Sopro and De Götzen. It
would not have been feasible to have named the
group Satelec, Pierre Roland, Sopro, De Götzen
and so on. We saw the necessity for a group name
while maintaining the companies’ individual
names. So the group is now named Acteon but
the different companies that we acquired and
that merged are identified as companies with
their own history and their own products. This is
also good for the employees, who still identify
with their original companies while belonging
to a large group. So we have kept the history of
each company, but we have grouped them under
the umbrella of Acteon. Satelec is still known in
countries like France. Pierre Rolland, which is a
60-year-old company, is still famous, so it’s a little bit difficult to introduce the name of Acteon.
Eight years on, awareness is growing, although
the individual company names of Pierre Rolland
and Satelec are still better known than the umbrella group of Acteon.
In countries where our history is shorter, like
the USA, Asia or Australia, Acteon is now known
as a company, and the different companies like
Satelec, Pierre Rolland and Sopro as divisions.
We found a way to keep the identity of each company in the group, while building a brand name
that encompasses all of them.
_With a turnover of €113 million and a growth
rate of 16 % in 2010, last year was a tremendous
success for the Acteon Group. 80 % of sales were
recorded in France. How was 2011 for you, and
which markets do you consider most important
for the group?
2010 was another big and successful year
with a 16 % increase. In 2011, we expect another
9 % increase in sales, which is good if you
consider the economic situation. Europe will
[19] =>
CAD0112_01_Title
CAD0112_18-20_Acteon 26.03.12 14:51 Seite 2
feature _ interview
I
account for a stable 2 % and the US for 10 %. But
the highest growth we are experiencing is in
China, at approximately 20 %. In general, Asia
currently accounts for 20 % of our global sales,
so if we achieve a 20 % increase, we will be very
satisfied. Countries like Japan and India in particular are very strong markets for us, as was
Thailand until November, before floods plagued
the country.
2011 and the coming years will definitely
be driven by Asia, and especially by China,
where we have been established since 1987.
We now have a team of 40 people there and
expect an average growth of 30 % over the
next five years. China is definitely a booming
market.
_When we talk to other European companies who sell on the Chinese market, they
often mention price sensitivity and the need
to adapt to the local price level.
No, I don’t think it’s a question of price—
it’s a question of mentality in China. They
have cheap copies of all our products there.
Twenty years ago, we sued the copycats.
However, we realised that this
was not productive because if
the company simply closes and
reopens in the next garage, you
are fighting a lost cause. More
importantly, we realised that the Chinese copies are our best advertising because the
quality is very poor and the design is just ridiculous. Dentists first buy a Chinese copy but then
they experience so many problems. As soon as
they have the money to buy a European product
at a European price, they will buy it. The fake
Rolex made in China is sold in Europe, but the
real Rolex made in Switzerland is sold in China.
And the proper business-orientated Chinese
client with a long-term plan will never buy a fake
product.
On the other hand, we are seeing an alarming
trend reversal in Europe. There are so many fake
or copy products from China imported into
Europe with a fake CE number or with a fake ISO
9000. The customs duties in the Shenzhen area
do not block these fake products, so any kind of
product can enter into Europe. These are healthcare devices to treat patients and they should
not put patients in danger.
_Do you believe that you will still be able to
manufacture in France or in Europe in the future?
Acteon’s policy is to manufacture and conduct research in Western Europe, and not to
manufacture in China,
South-East Asia, Brazil, India, or anywhere else.
Our policy is to produce continuously in Western
Europe. Our factories are in France, Italy and
Germany. Acteon has established itself in a niche
of the health-care market. This market is driven
by quality and innovation. Western Europe is
best known for these qualities and, consequently, you have to have your factory here to
produce at such a level and to generate innovation based on the technology. This is Acteon’s
philosophy.
Over the past 30 years, we have invested a
large amount of the company’s profits in R & D.
We currently have a total of 70 people in our
R & D departments in the different companies,
and our growth is definitely driven by innovation
and quality.
_You have invested in the digital dentistry
market in particular…
We invest a lot in the digital dentistry market
indeed. This is one of the fastest-growing mar-
CAD/CAM
1_ 2012
I 19
[20] =>
CAD0112_01_Title
CAD0112_18-20_Acteon 26.03.12 14:51 Seite 3
I feature _ interview
kets today and we have reached a point where we
are able to offer more or less the complete range
of products. Only the panoramic is missing;
however, within the next five to six years, the
panoramic might disappear from the market and
be replaced by the flat panel instead of the linear
panel. We therefore prefer to concentrate on the
flat panel, with a 2-D or 3-D reconstruction.
No one can deny any longer that the future of dentistry is digital. For example,
at Sopro, we manufacture a camera to
detect tooth decay with fluorescence
technology. So imaging is one thing,
but with imaging you can go to diagnosis. Imaging for a diagnosis is really
the key point of imaging, and if you
have a good diagnosis, you can have a
good treatment.
_Your new CBCT System,
WhiteFox, received the red dot design award in
2011, which recognises exceptional industrial
design. What is the response from the market,
and how are the sales figures for the WhiteFox
system?
We place a heavy emphasis on design at
Acteon for three reasons. The first reason is that
the dental clinics are usually well designed
because the patient is awake. It is not like a hospital, where the patient is under anaesthesia
and asleep and does not care about his environment. In a dental clinic, patients like to have
a nice environment to lower the stress of the
experience.
Another point is that the dental assistant is
participating increasingly in the choice of products. The clinical team likes nice designs and
colours, whereas the dentist tends to be more
attracted by technical features. But the dental
assistant is playing an increasingly important
role in decision-making when it comes to new
acquisitions.
The WhiteFox was very well received by the
market. The design is nice, but the technology is
really advanced. For example, WhiteFox is the
only scanner of its kind to feature a Hounsfield
units calibration. This calibration is used for
measuring bone density in order to allow for perfect planning and, if needed, for bone grafting
prior to implantations.
20 I CAD/CAM
1_ 2012
Since the introduction of cone-beam technology to general dental and maxillo-facial
surgery, ENT surgeons have become increasingly
attracted to this form of technology and are thus
becoming a very important market segment for
this kind of product.
The large viewing area for the ear, nose and
throat is especially convenient. We have good
synergies with our medical division, which is also
specialised in the ENT area. You see, there are
many bridges between the dental and medical
fields, between endoscopy in the medical and
imaging in the dental field, between radiology in
the dental and imaging in hospitals or ENT. We
are pleased with the cone beam, and the sales
figures are within our expectations.
_You are Platinum sponsor of the upcoming
Europerio Congress in Vienna. What can visitors
expect from Acteon there?
Basically, we are very involved in preventive
and conservative dentistry. Periodontics has
always played a major role in these areas and
Europerio is considered to be the leading congress in this specialty worldwide. We have purposefully chosen to become Platinum sponsor of
the congress because of the quality of its scientific programme and the excellent standing of
the congress in the dental community.
Acteon will stage sponsored sessions on
Wednesday, 6 June, from 16:00 to 17:00 (this
includes a session hosted by Dr Bennani entitled
A new gingival retraction technique for implants).
On Friday, 8 June, from 12:15 to 13:45, there will
be a novel procedure for evaluating plaque status and soft-tissue inflammation using an intraoral camera. These sessions will be of interest to
dental hygienists, general dentists and periodontists. The crème de la crème of international
speakers will reveal tips and tricks from their
professional lives, and we invite everyone cordially to join us in Vienna._
_contact
Acteon Group
17 av. Gustave Eiffel
Z.I. du Phare
33708 Merignac
France
info@acteongroup.com
www.acteongroup.com
CAD/CAM
[21] =>
CAD0112_01_Title
Anschnitt DIN A4
08.03.2010
9:16 Uhr
Seite 1
[22] =>
CAD0112_01_Title
CAD0112_22-25_Cacaci 26.03.12 14:52 Seite 1
I industry report _ CAMLOG Guide System
Full-arch reconstruction of
the edentulous maxilla with
the CAMLOG Guide System
Author_ Dr Claudio Cacaci, Germany
Fig. 1_Panoramic radiograph.
The maxillary posterior regions
on both sides show significantly
reduced vertical bone height
(residual height less than 2 mm).
Fig. 2_Clinical situation with
removable telescopic
prostheses inserted.
Fig. 3_The facial maxillary sinus wall
is moved inwards and becomes the
neurocranial floor of the maxillary
sinus. On the left side, a vertical bone
septum (visible on Fig. 1) requires
two separate lateral approaches.
Fig. 4_Filling of the right sinus cavity
with blood and xenogeneic bone
substitute material. Coverage of the
lateral window with a resorbable
collagen membrane to avoid
displacement of the bone
substitute material.
Fig. 5_Post-op panoramic
radiograph shows filling of both
maxillary sinus cavities.
Fig. 6_Panoramic radiograph with
scan prosthesis for determining
the fixation positions using the
four interim implants.
Fig. 7_Two-part temporary implants
fitted with ball abutments in positions
11 and 21. Posterior anchorages
in positions 15 and 25.
Fig. 8_The system-specific matrices
are placed and secured in the
scan template with plastic.
Fig. 9_Fixed ball abutment matrices
in scan template. The DVT image is
taken immediately with the radiology
template mounted.
22 I CAD/CAM
1_ 2012
Fig. 1
Fig. 2
_A 59-year-old male patient was looking
for a new fixed restoration for his maxilla. His
case history showed no general disease. The
patient had been fitted with telescopic model
casting prostheses in the maxilla and mandible.
Owing to the periodontally insufficient anterior residual teeth in the maxilla (teeth #12, 11,
21 and 22), the prosthesis could no longer be
supported. After losing the residual teeth, the
Fig. 3
patient wanted a fixed implant-based restoration of the maxilla.
The residual teeth of the mandible showed the
following findings. Tooth #48 was impacted and
displaced. Tooth #45 showed mobility (Grade 3)
and was periodontally insufficient.
The anterior residual teeth #33 to 43 presented with increased probing depths on the
canine teeth and increased mobility (Grade 2).
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
[23] =>
CAD0112_01_Title
CAD0112_22-25_Cacaci 26.03.12 14:52 Seite 2
industry report _ CAMLOG Guide System
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
The treatment strategy for the maxilla included, as a first step, a conservative periodontal
therapy of the anterior residual teeth for strategic preservation and fixation of the existing
prosthesis until implant insertion.
Afterwards, the residual teeth were removed
and a bilateral sinus floor augmentation was
performed in a two-stage procedure. Following
3-D planning, eight endosseous implants were
inserted with the CAMLOG Guide System in a
I
Fig. 10_Transversal view at region
26. The central axial borehole is
clearly visible and there is good
ossification in the sinus.
Fig. 11_All views at implant region
27. From left to right: lateral view
with projection of the temporary
implant in region 25, transversal
view, panoramic anatomic view,
occlusal view.
Fig. 12_Transversal view at 24.
Fig. 13_Transversal view at 23.
Fig. 14_Transversal view at 17.
Fig. 15_All views at implant region
16. From left to right: lateral view
with projection of the temporary
implant in region 15, transversal
view, panoramic anatomic view,
occlusal view.
Fig. 16_Transversal view at 14.
Fig. 17_Transversal view at 13.
Fig. 18_Transversal view at 12.
flapless procedure, and the prosthetic restoration was realised using a telescopic bridge.
In the mandible, tooth #45 was removed and
the other teeth were treated with conservative
periodontal therapy. The mandibular posterior
teeth were replaced and realigned. Teeth #43 to 33
received re-veneering of the removable denture.
The planned minimally invasive flapless procedure for implant insertion requires a unique
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 23
Fig. 24
Fig. 19_Surgical template with ball
retention elements at positions 21,
15 and 25 for stable positioning
of the template during drilling
procedures. Careful cleaning
and disinfection are mandatory
before placement.
Fig. 20_Ball retentions on temporary
implants for stabilisation of the
temporary prosthesis, fixation of
the scan template during cone-beam
scan and positioning of the surgical
template during the drill procedure.
Fig. 21_The gingival punch is guided
through the sleeves into the mucous
membrane. The punch
has no depth stop.
Fig. 22_A scalpel is used to cut out
and remove the punched gingival
islands after removing the template.
Fig. 23_Resected implant
locations 26 and 27.
Fig. 24_The template is mounted
again. Start of the CAMLOG Guide
drilling sequence with the pilot drill
followed by drills of the appropriate
lengths depending on the implant
length (region 23).
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Fig. 25_Guided insertion through
the sleeves utilising the
CAMLOG Guide insertion tool.
Fig. 26_The sleeve dimension
allows for bone-condensing and
bone-spreading procedures through
the sleeve (here, osteotome
for vertical bone condensation).
Fig. 27_Implants in first quadrant
in situ. Depth stops on the
surface of the sleeves.
Fig. 28_Post-op panoramic
radiograph.
Fig. 29_Healing after one week
post-op. The patient had neither
complaints nor post-op swelling.
Fig. 30_The surgical template is
set back on its fabrication model.
The analogue plaster reamers are
used to create the cavity for the lab
analogue through the sleeve.
Fig. 31_Implant positions on the
plaster cast.
Fig. 32_Mounted lab analogues
together with the insertion posts are
secured to the sleeves with wax.
The lab analogues are fixed
into the plaster cast.
Fig. 33_Cast with lab analogues
in place. The transfer of the analogue
into the correct position through
the sleeve of the surgical stent.
Fig. 34_A 0.5 mm thick
thermoformed splint is drawn over
the abutments. The thermoformed
copings perform the space-making
task for passivation when cementing
the interim restoration.
Fig. 35_Long-term temporary
appliance in the articulator.
Fig. 36_PEEK abutments in situ.
Fig. 37_Long-term temporary
appliance cemented in situ
in terms of early treatment
eight weeks post-op.
Fig. 38_Impression with closed
impression posts.
Fig. 39_CAD/CAM-fabricated
zirconia abutments bonded to
CAMLOG Esthomic inset abutments.
24 I CAD/CAM
1_ 2012
Fig. 25
Fig. 26
Fig. 27
Fig. 28
Fig. 29
Fig. 30
Fig. 31
Fig. 32
Fig. 33
fixation for the preparation of radiological materials. The fixation is facilitated by temporary
implants in a suitable position.
A bone-anchored and prosthetic-oriented scan
can be taken under radiological control owing to
the unique fixation of the scan template using
the interim implants.
In order to ensure accurate transferability, the
fixation must be performed under radiological
control in the identical position as the one for
the implantation.
The thickness of the mucous membrane can
be measured by fitting the radio-opaque tooth
along the plaster surface.
The scan template is fabricated based on
prosthetic requirements (functional, aesthetic).
The distance from holding sleeve to bone
surface must not exceed 3.5 mm.
Fig. 34
Fig. 35
Fig. 36
Fig. 37
Fig. 38
Fig. 39
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Fig. 40
Fig. 41
Fig. 42
Fig. 43
Fig. 44
Fig. 45
CAD/CAM was used to fabricate the bridge
framework from a fibre composite (Everest
C-Temp, KaVo) and veneered with an acrylic material. For passivation of the design, proven electroplating was used. Custom CAD/CAM-fabricated zirconia abutments were selected.
_Conclusion
The original goal of the prosthetic reconstruction was a fixed bridge restoration. Owing
to the hygienic and functional training phase
with the long-term temporary appliance, the
patient opted for a removable bridge.
A complete list of references is available from the publisher.
The drilling sequence in the CAMLOG Guide
System is different from other systems. While in
a conventional drilling sequence, the pilot drill is
advanced to the final implant length, the drilling
sequence guided by the CAMLOG Guide first
starts with the shorter pilot drill (length 6 mm).
To guide all drills by the sleeve geometry from
the start, the drilling sequence is performed in
succession from the 9 to the 11 mm drill and
finally to the 13 mm drill (maximum implant
length).
The CAMLOG Guide offers a sleeve system. As
opposed to multi-sleeve systems, a single sleeve
Fig. 40_CAD/CAM-fabricated
zirconia abutments after
one year in function.
Fig. 41_Veneering work.
Fig. 42_Occlusal view
before treatment.
Fig. 43_Radiological situation
before treatment.
Fig. 44_Occlusal view two years
after final prosthetic restoration.
Fig. 45_Radiological situation
two years after loading.
inserted into the surgical template is adequate
for guidance during all drilling sequences and
implantation procedures. The implants can be
inserted through the sleeves._
Editorial note: The case was first published in C. Mairoana
& M. Beretta (eds.), Manual of Oral Implantology (Edizioni
Italia Press, 2010) and is reprinted here with kind permission.
The accuracy and simplicity with which the
implants can be inserted in prosthetically correct
or anatomically difficult situations is increased
significantly by virtual 3-D implant planning
using CBCT or CT in combination with the guided
implant bed preparation and implant insertion.
Implant therapy is thus facilitated.
I
_about the author
CAD/CAM
Dr Claudio Cacaci is a
specialist in Oral Surgery and
Implant Dentistry. He studied
at the Dental School in Munich
and worked in the Department
of Maxillo-Facial Surgery and
the Department of Oral
Surgery and Implant Dentistry
in Munich. In 1997, he founded a private dental
clinic with Dr Jan Hajtó in Munich. In 1998, he
established the Private Training Center for Implant
Dentistry (F.I.O.I.) in Munich. He is the founder of
the Munich Study Group for Implant Dentistry and
a member of various national and international
study groups and dental associations. Dr Cacaci
is author of the book Checklist – Implantology
and contributing author of the book Manual of
Oral Implantology . Since 2009, he has worked
in a group practice specialising in implantology and
periodontology in Munich.
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I industry report _ lithium disilicate
Lithium disilicate,
the restorative material
of multiple options
Authors_ Lee Culp & Prof Edward A. McLaren, USA
Fig. 1_Pre-existing clinical condition
of mandibular molar to be restored.
Fig. 2_Mandibular molar restored
with CAD/CAM-designed and -milled
e.max restoration, using stain and
glaze technique for aesthetics.
Fig. 3_Pre-existing clinical condition
of maxillary posterior quadrant
to be restored.
Fig. 4_Maxillary posterior quadrant
restored with CAD/CAM-designed
and -milled e.max restorations,
using a micro-layering technique
for aesthetics.
(Clinical dentistry in Figure 3 & 4
was done by Dr Michael Sesseman)
26 I CAD/CAM
1_ 2012
Fig. 1
Fig. 2
_As dentistry continues to evolve, new technologies and materials are continually being offered
to the dental profession. Throughout the years,
restorative trends and techniques have come and
gone. Some material developments have transformed the face of aesthetic dentistry, while other
initial concepts have phased out and died. Today
all ceramic restorations continue to grow in the
area of restorative dentistry, from pressed ceramic
techniques and materials to the growing use of zirconia, and new materials that can be created from
CAD/CAM technology. This article will explore new
uses for the all-ceramic material, known as lithium
disilicate, and the use of a digital format to design
and process this material in new and exciting ways.
An overview of the material and unique clinical
procedures will be presented.
_Introduction
Fig. 3
Fig. 4
Embracing proven alternative solutions and
transforming traditional methods can be challenging to dental restorative teams facing increasing
patient demands while being tasked with delivering
high-strength restorative options without compromising the aesthetic outcomes. Traditionally, dental
professionals have used a high-strength core material made of either a cast metal framework or an
oxide-based ceramic (such as zirconia or alumina).
This approach has two disadvantages.
Compared with glass-ceramic materials, the
substructure material has high value and increased
opacity but may not be aesthetically pleasing.1 This
is especially an issue in conservative tooth prepa-
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I
Fig. 5_Pre-existing clinical
condition of maxillary anterior teeth
to be restored.
Fig. 6_Veneer preparations
for the anterior restoration.
Fig. 5
Fig. 6
ration when the core material will be close to the
restoration’s exterior surface.
With a monolithic technique (Figs. 1 & 2), most
restorations built from lithium-disilicate materials
can be completely fabricated. This approach provides high strength and aesthetics but requires
surface colourants for the final shade. When indepth colour effects are needed, a partial layering
technique may be employed. Although no longer
a purely monolithic structure (Figs. 3 & 4) because
the restoration maintains a large volume of the
core material, the resulting restoration should reasonably maintain its high strength. However, no
evidence supports this.
The other disadvantage is that although the
high-strength material has great mechanical properties, the layering ceramic with which it is veneered
exhibits a much lower flexural strength and fracture toughness.2, 3 The zirconia core (with a 900 to
1,000 MPa flexural strength) is less than half of the
cross-sectional width of a restoration; it must be
completed with a veneering material with a flexural
strength in the range of 80 to 110 MPa (depending
on delivery method).4 The veneering material tends
to chip or fracture during function. Also, such
restorations depend significantly on the ability to
create a strong bond interface between the dissimilar materials of oxide-ceramic and silica-based
glass-ceramic, a bond that is not difficult to create.5
However, the quality of the bond interface can vary
substantially because of cleanliness of the bond
surface, furnace calibration, user experience and
other issues.
In today’s industry, monolithic glass-ceramic
structures can provide exceptional aesthetics without requiring a veneering ceramic. Greater structural integrity can be achieved by eliminating the
veneered ceramic and its requisite bond interface.6
The relative strength of the available glass-ceramic
material has traditionally been the disadvantage of
these restorations. Owing to their flexural strength
of 130 to 160 MPa, they are limited to single-tooth
restorations, and adhesive bonding techniques are
needed for load sharing with the underlying tooth.6
This has been resolved through the development
of highly aesthetic lithium-disilicate glass-ceramic
materials.
The 70 % crystal phase of this unique glassceramic material refracts light very naturally, while
also providing improved flexural strength (360 to
400 MPa).7 This gives more indications for use and
the ability to place restorations using traditional
cementation techniques, while also having strength
and aesthetics.
_Aesthetic options
If covering or masking underlying tooth structure is part of the treatment plan, the restorative
team can imagine doing so in an aesthetic way.
The ceramist can make that vision a reality with
IPS e.max (Ivoclar Vivadent) by using a very high
opacity ingot. Ingot opacities available for IPS e.max
include high opacity (HO), medium opacity (MO),
low translucency (LT) and high translucency (HT).7
The MO ingot can be used as an anatomic framework
material if restorations must be fully layered. LT ingot can be employed with stain and glaze methods
Fig. 7_E4D LabWorks system
used for the scan, design, and milling
of the veneer restorations.
Fig. 7
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Fig. 8
Fig. 9
Fig. 8_Computerised image
of digital 3-D model.
Fig. 9_Computerised 3-D digital
composite file, showing preparation,
provisional models and digital
restoration design.
Fig. 10_Final digital restorations,
with cut-back design for the
micro-layering of enamel ceramics.
or hybrid layering techniques, which have been
used for years with IPS Empress Aesthetic (Ivoclar
Vivadent). The HT ingot is meant for stain and glaze
techniques.
Choosing one of these four different aesthetic
options depends on the preparation and the technique to be used in order to match the adjacent
dentition or restorations. In addition, the laboratory can select the processing choice that is
appropriate for the selected restoration. IPS e.max
includes press and CAD/CAM options because
lithium disilicate can be pressed from ingot form
or milled from a block form. If the CAD/CAM option
is used, the technician will design the restoration digitally rather than perform a full wax-up and
invest/press.
_Preparation options
If LT or HT ingots will be needed, then dentists
can have flexibility with their preparations because
of the translucent margins. This is the situation with
partial preparations (for example inlays, onlays
and veneers)—the margins can be placed wherever
clinically proper. IPS e.max’s translucency enables
dentists to place the margins virtually anywhere
on the restoration, blending seamlessly with the
natural dentition.
Dentists can use a traditional preparation of
1.0 to 1.5 mm reduction (for example a full-crown
preparation) if they need more opaque materials
(for example HO and MO). Because the resulting
restoration will have a slight opacity, the margins
will be equi-gingival or slightly sub-gingival. In
either case, the material will be fully layered to
create the final restoration. IPS e.max provides the
choice of using traditional or creative preparation
designs.
_Cementation options
Because lithium disilicate can be fully light-cure
bonded or cemented using a self-etching primer with
conventional resin-cement techniques, IPS e.max
28 I CAD/CAM
1_ 2012
Fig. 10
also provides options for cementation. Conventional self-etching primer cement is ideal for full
crowns. For partial and veneer preparations for
which adhesive protocol will be used, full light-cure
bonding is preferred.
_Case study
A 42-year-old female presented with discoloured teeth that had been repaired with various
composite restorations placed throughout the
years (Fig. 5). A lingual amalgam restoration in tooth
#12 and composite restorations in teeth #23, 21, 11
and 13 showed recurrent decay that was diagnosed
with digital X-rays. She possessed a negative medical history and good oral hygiene with resultant
periodontal health and asymptomatic teeth. Treatment options of zirconia or porcelain-fused-tometal crowns or CAD/CAM all-ceramic restorations
were discussed with the patient.
Ultimately, CAD/CAM all-ceramic restorations
were tested. When proper preparation and occlusal
design considerations are followed, properly placed
CAD/CAM-designed and -milled restorations have
been extremely successful. The patient made a
preparation appointment, during which the existing
restorations were removed, and teeth #23 to 13
were prepared for all-ceramic veneer restorations,
following accepted CAD/CAM glass-ceramic preparation guidelines (Fig. 6): adequate clearance,
rounded internal aspects, and equi-gingival buttjoint margins were ensured. Once the preparations
were completed, conventional impressions were
taken and poured in high-quality, laser-reflective
dental stone.
Laboratory communication
The dentist is to the dental technician what the
architect is to the builder. Each has a primary role
in indirect restorative dentistry, which is to imitate
natural function and aesthetics perfectly and translate that into a restorative solution. The communication between the clinician and technician entails a thorough transfer of information, including
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functional components, occlusal parameters, phonetics and aesthetics, and continues throughout
the restorative process, from the initial consultation
through treatment planning and provisionalisation
to final placement.
The primary and conventional communication
tools between the dentist and technician are:
_photography;
_written documentation;
_impressions of the patient’s existing dentition;
_clinical preparation; and
_opposing dentition.
This information is used to create models, which
are mounted on an articulator to simulate the mandibular jaw movements.
and delivers them to the patient. Similar to how the
Internet has transformed the communication landscape, the possibility of using CAD/CAM-restoration
files electronically has spurred evolutions in the
way dental restorative teams perceive and structure
the dentist–laboratory relationship.
The digital process
When the E4D LabWorks system (D4D Technologies) was introduced in 2008 (Fig. 7), it was the first
computerisation model to present a real 3-D virtual
model accurately and account for the occlusal effect
of the opposing and adjacent dentition automatically. It enables the user to design 16 individual, fullcontour, anatomically correct teeth simultaneously.
The device condenses the information from a complex occlusal case and displays it in a user-friendly
format that allows clinicians with basic knowledge
of dental anatomy and occlusion to modify the design. Once this has been completed, the information
is sent to the automated milling unit.
The innovation of digitally designed restorations meant that some of the more mechanical and
labour-intensive procedures (for example waxing,
investing, burn-out, casting and pressing) involved
in the conventional fabrication of a restoration were
essentially automated. The dentist and technician
had a consistent, precise method to construct functional dental restorations.
Fig. 11
Fig. 11_IPS e.max milling blocks,
shown in blue stage.
Traditional indirect restorative process
The indirect restorative process involves the
following steps:
1. The clinician prepares the case according to the
appropriate preparation guidelines, takes the
impressions, sends these and other critical communication aspects to the laboratory, and the laboratory receives all the materials from the dentist.
2. Then, the impressions are poured, models mounted, and dies trimmed.
3. Appropriate restorations—layered, pressed, milled,
cast, or combinations—are made.
However, as restorative dentistry shifts further
into the digital era, clinicians must change their
perceptions and definitions of the dental laboratory.
Traditionally, a laboratory is the site that receives
and processes patient impressions and returns the
completed restorations to the clinician, who adjusts
30 I CAD/CAM
1_ 2012
A file is created within the design software for
each patient. The operator can input the patient’s
name or record number and selects the appropriate
tooth number(s) to be treated. Each tooth’s planned
restoration is checked (for example full crown, veneer, inlay and onlay). Lastly, additional preferences
include material choices and preferred shade.
System defaults that can be set ahead of time or
changed for each patient are preferred contact
tightness, occlusal contact intensity and virtual die
spacer, which determines the internal fit of the final
restoration to the die/preparation. All this information can be entered prior to treatment or changed at
any time if the actual treatment differs from what
was planned.
When the images of the preparation, provisional
restorations and opposing dentition are captured,
the computer has all the required information for
preparing the working models, preparation and
opposing model. The real 3-D virtual model is then
shown on the screen and can be rotated and viewed
from any perspective (Fig. 8). In designing the
restoration, the first step must be to define the final
restoration’s parameters digitally. This is achieved
by employing the opposing and adjacent teeth for
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I
Fig. 12_Milled e.max full contour
posterior restoration, shown
in blue stage.
Fig. 13_Milled e.max full contour
posterior restoration, shown in final
crystallised stain and glaze stage.
Fig. 12
Fig. 13
occlusal interproximal contact areas and, finally, the
gingival margins of the preparation.
tual restorations have been completely designed
(Fig. 10), the milling chamber with the predetermined shade, opacity and size of the IPS e.max block
is loaded, an on-screen button is pressed, and an
exact replica of the design is produced in ceramic
in a short time.
Using input and neighbouring anatomic detail
as a basis, the software will place the restorations in
an appropriate position—but not to the clinically
ideal location. Instead, the operator relies on his
or her knowledge of form and function and experience to reposition and contour the restoration. As
the crown’s position and rotation are fine-tuned,
the software’s automatic occlusion application will
readjust each triangular ridge and cusp tip—and
the restoration’s contours, contacts and marginal
ridges—employing the preferences and bite-registration information. The virtual restoration adapts
all parameters in relation to the new position. Instantaneously, the position and intensity of each
contact point is illustrated graphically and colour
mapped, where it can easily be modified based on
the operator’s and clinician’s preferences.
Through a variety of virtual carving and waxing
tools, customisation and artistry are also possible.
These tools can be used to adjust occlusal anatomy,
preferences and contours, reflecting actual laboratory methods. Each step in the process is updated
on the screen; therefore, the effect of any changes
is immediately apparent. For this case, three files
were loaded into the computer software for restoration design. Scans of the preparations, provisional
restorations and opposing dentition were joined to
form a composite file that represented the patient’s
oral situation accurately (Fig. 9). Once the final vir-
Fig. 14
Glass-ceramics are categorised according to
their chemical composition and/or application. The
IPS e.max lithium disilicate is composed of quartz,
lithium dioxide, phosphorus oxide, alumina, potassium oxide, and other components.7 These powders
are combined to produce a glass melt, which is
poured into a steel mould, where it cools until it
reaches a specific temperature at which no deformation occurs. This method results in minimal
defects and improved quality control (owing to the
translucency of the glass). The blocks or ingots are
generated in one batch, based on the shade and size
of the materials. Owing to the low thermal expansion that results during manufacture, a highly thermal, shock-resistant glass-ceramic is produced.
Next, the glass ingots or blocks are processed
using CAD/CAM-milling procedures or lost-wax
hot-pressing techniques (IPS e.max Press; Fig. 11).
The IPS e.max CAD blue block is based on two-stage
crystallisation: a controlled double nucleation process, in which the first step includes the precipitation of lithium-metasilicate crystals. Depending on
the quantity of colourant added, the resulting glassceramic demonstrates a blue colour. This ceramic
has superior processing properties for milling. After
Fig. 15
Fig. 14_Milled e.max cut-back
anterior restoration, shown
in blue stage.
Fig. 15_Milled e.max cut-back
anterior restoration, shown in final
crystallised micro-layered
and glazed stage.
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Fig. 16
Fig. 17
Figs. 16–18_Maxillary anterior
section restored with
CAD/CAM-designed and -milled
e.max restorations, using
a micro-layering technique
for aesthetics.
the milling process, a second heat-treating process
is performed in a porcelain furnace at approximately 850 °C, at which temperature the metasilicate
is dissolved and the lithium disilicate crystallises.
This results in a fine-grain glass-ceramic with 70 %
crystal volume incorporated into a glass matrix.
With two crystal types and two microstructures
during processing, the IPS e.max CAD material
demonstrates distinctive properties during each
phase. The intermediate lithium-metasilicate crystal structure promotes easily milling, without excessive bur wear, while maintaining high tolerances and marginal integrity. In the blue stage, the
glass-ceramic contains approximately 40 % volume
lithium-metasilicate crystals that are approximately 0.5 µm. The final-stage microstructure of lithium
disilicate gives the restoration its superior mechanical and aesthetic qualities. In this stage, the glassceramic contains approximately 70 % volume
lithium-disilicate crystals that are approximately
1.5 µm (Figs. 12–15).
Fig. 18
onto the internal surfaces of the glazed restorations. Then they were rinsed and dried. This was followed by a silane coupling agent (Monobond-S,
Ivoclar Vivadent), which was also placed for a
minute onto the internal surfaces, and then airdried. For the final cementation, Variolink Veneer
(Ivoclar Vivadent) was used. After excess cement
had been removed, final light-curing was done. The
occlusal contacts were then reviewed and excursive pathway freedom was confirmed. Owing to the
correct capture and alignment of the bite-registration information, few adjustments were required.
_Conclusion
IPS e.max is about restorative options. Dentists
and technicians now have a material with which
they can do anterior or posterior restorations. With
four different opacities or translucencies available,
a variety of creative aesthetic options can be accomplished in a restoration. Dentists and their laboratory ceramists now have the opportunity to be
more creative for their patients (Figs. 16–18)._
The laboratory process
Once designed and milled, the IPS e.max ceramic
restorations are then prepared for final aesthetic adjustments. After the milling sprue has been removed,
the technician defines surface texture and occlusal
anatomy using diamond and carbide burs, carefully
avoiding any alteration to the perfected occlusal
and interproximal contacts. Afterwards, restorations
are rinsed to remove surface debris and dried. Then,
the milled blue restorations are placed in a conventional ceramic furnace for the crystallisation process. These restorations were digitally designed with
an incisal cut-back design that will allow a minimal
application of translucent ceramics to mimic the
incisal effects found in nature. Contoured to final
anatomic shape, the restorations are further aesthetically improved by subtle colouring and glazing.
Restoration placement
Next, 5 % hydrofluoric acid (IPS Ceramic Etching
Gel, Ivoclar Vivadent) was applied for 30 seconds
32 I CAD/CAM
1_ 2012
Editorial note: A complete list of references is available
from the publisher.
_about the authors
CAD/CAM
Lee Culp
Chief Technology Officer,
Microdental Laboratory,
Dublin, California
Prof Edward A. McLaren
Professor, Founder and
Director, UCLA Post Graduate
Esthetics; Director, UCLA
Center for Esthetic Dentistry,
Los Angeles, California
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CAD/CAM
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[34] =>
CAD0112_01_Title
CAD0112_34_Sirona 26.03.12 14:55 Seite 1
I industry news _ Sirona
CEREC announces its
next anniversary
_Waiting for the big 30 just won’t cut it!
That’s why Sirona, the company that pioneered
digital dentistry more than 26 years ago and the
world’s leading producer of dental CAD/CAM systems, is celebrating the 27-and-a-half-year anniversary of its industry-changing CEREC dental
CAD/CAM system with a three-day extravaganza
from 16 to 18 August 2012 at the Venetian Resort
Hotel Casino in Las Vegas.
Commenting on the humorous name of the
event, CEREC 27-and-a-half, President of Sirona
Dental Systems, LLC, Michael Augins said: “We
simply can’t wait another two-and-a-half years
to get our customers together again. We had more
than 3,000 attendees at CEREC 25 and their enthusiasm for our products and the success of the
programme has encouraged us to do it all over
again.”
X
Earlier this year, Sirona launched CEREC Software 4.0, which was the most advanced and comprehensive redesign in the history of the CEREC
software platform. “We feel the need to celebrate
our ongoing success with our most loyal customers and friends,” commented Augins. “What’s
more, an event this big needs the best possible
venue, and the Venetian in Las Vegas is the ideal location to host what we believe will be the biggest
and best CEREC event to date.”
For those who prefer round numbers in their
company milestones, the CEREC 27-and-a-halfyear anniversary celebration will also commemorate the 20th anniversary of Schick digital radiography, the tenth anniversary of Sirona’s inLab
Dental Lab CAD/CAM System and the fifth anniversary of the GALILEOS Digital Imaging System.
In addition to CEREC, special education tracks will
highlight these product lines to broaden the appeal of the event. The event, according to Augins,
is geared towards all dental and laboratory professionals and follows Sirona’s traditional and successful continuing education (CE) event formula,
consisting of education, A-list entertainment,
networking and fun.
34 I CAD/CAM
1_ 2012
As during the CEREC 25 event, CEREC 27-anda-half will offer participants the opportunity to
earn up to 18 CE credits across a comprehensive
spectrum of topics and tracks, and will offer premium entertainment and memorable parties.
There will also be an exhibit hall showcasing top
dental companies and their products and services.
As usual, Sirona also plans to showcase the who’s
who of digital dentistry. Although final details are
still in progress, the following marquee lecturers
have already agreed to participate: Dr Gordon
Christensen, Dr Frank Spear, Dr Rella Christensen,
Prof Andreas Bindl and Imtiaz Manji.
“The CEREC 27-and-a-half celebration will be
a great destination for advanced CAD/CAM and
digital dentistry education provided by the best
educators in our field, as well as a great open
communication forum for Sirona, our colleagues,
clients, associates and other professionals who
hold the same interests,” commented Roddy
MacLeod, Vice-President of CAD/CAM for Sirona
Dental Systems. “It will be the digital event of the
year!”
Although August may seem far on the horizon, space is limited and dental and dental laboratory professionals are encouraged to visit
www.CEREC27andahalf.com or call +1 888 23
CEREC for additional information as it becomes
available, including special early registration tuition and lodging packages._
_contact
Sirona Dental Systems
4835 Sirona Drive
P.O. Box 410100
Charlotte, NC 28273
USA
www.sirona.com
www.cereconline.com
www.CEREC27andahalf.com
CAD/CAM
[35] =>
CAD0112_01_Title
[36] =>
CAD0112_01_Title
CAD0112_36_3M 26.03.12 14:56 Seite 1
I industry news _ 3M ESPE
Introducing Lava Ultimate
CAD/CAM Restorative
A new class of CAD/CAM material
_3M ESPE recently introduced Lava Ultimate
CAD/CAM Restorative, a unique new CAD/CAM
material with long-lasting aesthetics and performance. Based on 3M ESPE’s renowned nanotechnology, Lava Ultimate CAD/CAM Restorative offers
a polish that lasts and backs it up with a ten-year
warranty—something no other chairside block can
match.
“This material saves dental professionals time in
two ways—by providing a faster milling time and by
eliminating the need for an additional firing step,”
said Mark Gates, Vice-President of Sales and Marketing, 3M ESPE. “Our confidence in this material
is evidenced by our ten-year warranty, so dentists
can also feel confident using it in practice.”
3M ESPE Lava Ultimate
Restorative RNC.
(Photo courtesy of 3M ESPE)
This new class of CAD/CAM material provides
a fast, no-firing process that is easy to mill, helping
dentists maximise the productivity of their in-office
restorative systems. The unique restorative offers a
functionality that other chairside materials cannot:
Lava Ultimate CAD/CAM is resilient, non-brittle, and
is incredibly durable and shock absorbent. A few minutes of polishing are all that is necessary to achieve
an enamel-like lustre. The material also allows dentists to make adjustments easily, as well as build up
and reseal restorations. Lava Ultimate CAD/CAM
Restorative will be offered in eight shades, four of
which include both high and low translucencies,
giving dentists the choices they need to create
natural-looking restorations.
36 I CAD/CAM
1_ 2012
This new material builds upon two of 3M’s
core technology platforms: ceramics and nanotechnology. Lava Ultimate CAD/CAM Restorative is
formulated from a blend of approximately 80 %
nano-ceramic particles embedded in a highly cured
resin matrix using a 3M proprietary manufacturing
process. The result is a unique, patented material
that maintains a brilliant, long-lasting polish.
Lava Ultimate CAD/CAM Restorative is indicated
for a full range of permanent adhesive, single-unit
restorations, including crowns, onlays, inlays and
veneers. Additionally, the material is ideally suited
for implant-supported restorations because of its
high flexural strength and low wear. Lava Ultimate
CAD/CAM Restorative reduces stress to the implant,
and dentists can adjust the material for occlusion with
additive and subtractive techniques. With enamellike beauty, ease of use and guaranteed ten-year
durability, Lava Ultimate CAD/CAM Restorative gives
dentists an outstanding new way to maximise their
CAD/CAM systems, while offering patients a beautiful
and durable restoration. Finished restorations are
also available to dentists and laboratories through
Straumann CARES Digital Solutions, and the material
will be available in 2012 to Lava Milling Centers._
_contact
3M Corporate Headquarters
3M Center
St Paul, MN 55144-1000, USA
www.3m.com
CAD/CAM
[37] =>
CAD0112_01_Title
IDEM12 210x297mm DTI US Ad.ai
9/7/11
2:40:28 PM
www.idem-singapore.com
THE BUSINESS OF DENTISTRY
C
M
Y
CM
MY
CY
CMY
K
INTERNATIONAL DENTAL
EXHIBITION AND MEETING
APRIL 20 - 22, 2012
Limited space available. Secure your booth now!
We Bring the Asia Pacific Markets to You. IDEM Singapore connects you with
over 6,000 dental traders, distributers and practitioners from the Asia Pacific region.
Enriched with opportunities from the trading and showcasing of high-quality
dental equipment to learning and development in the field of dental practice,
this event is a “must-attend” for every dental and associated professional.
Endorsed By
Supported By
Held In
In Co-operation With
Co-organiser
Singapore Dental Association
North America
Franz Balve
Koelnmesse Inc
Tel: +1 732 933 1117
Fax: +1 732 741 6437
f.balve@koelnmessenafta.com
International
Stephanie Sim
Koelnmesse Pte Ltd
Tel: +65 6500 6723
Fax: +65 6296 2771
s.sim@koelnmesse.com.sg
[38] =>
CAD0112_01_Title
CAD0112_38_Platforms 26.03.12 14:57 Seite 1
I digital platforms _ course calendar
Announce your courses
in CAD/CAM!
LIVE EDUCATION SYMPOSIUM AT IDEM SINGAPORE
20–22 April 2012
Suntec Singapore, Singapore
The Dental Tribune Study Club would like to invite you to participate at our Live Education Symposium at IDEM
SINGAPORE. We will offer an ambitious schedule of continuing education (CE) lectures in various dental disciplines. Each
day will feature a selection of lectures led by experts in the field, providing an invaluable opportunity to learn from opinion
leaders, while earning ADA CERP CE credits. We are developing a program that is both diverse and engaging, with every
lecture offering practical guidance to take back to the practice and put to immediate use.
Dental Tribune America, LLC
c/o Christiane Ferret
116 West 23rd Street, Ste. 500, New York, NY 10011, USA
+1 424 744 0608
c.ferret@dtstudyclub.com
For more information and to reserve a spot for your course(s) in the upcoming issues, please contact
Vera Baptist, Product Manager CAD/CAM, at +49 152 29929405 or v.baptist@dental-tribune.com.
38 I CAD/CAM
1_ 2012
[39] =>
CAD0112_01_Title
Bella Center
Copenhagen
APRIL 26- 28, 2012 s "%,,! #%.4%2 s COPENHAGEN s $%.-!2+
Welcome to the 45th Scandinavian Dental Fair
The leading annual dental fair in Scandinavia
The 45th SCANDEFA invites you to exquisitely meet the Scandinavian dental market and
sales partners from all over the world in springtime in wonderful Copenhagen
SCANDEFA 2012
Exhibit at Scandefa
Is organized by Bella Center
and is being held in conjunction
with the Annual Scientific
Meeting, organized by the
Danish Dental Association
(www.tandlaegeforeningen.dk).
Book online at www.scandefa.dk
Sales and Project Manager, Christian Olrik
col@bellacenter.dk, T +45 32 47 21 25
175 exhibitors and 11.422
visitors participated at
SCANDEFA 2011 on 14,220 m2
of exhibition space.
Travel information
Bella Center is located just a 10 minute taxi drive from Copenhagen
Airport. A regional train runs from the airport to Orestad Station,
only 15 minutes drive.
Fotos from Bella Center, Wonderful Copenhagen
2012
Check in at Bella Center’s newly built hotel
Bella Sky Comwell is Scandinavia’s largest design hotel.
The hotel is an integral part of Bella Center and has direct
access to Scandefa. Book your stay on www.bellasky.dk
www.scandefa.dk
Scandefa_Ann_A4_ENG_2012.indd 1
01/06/11 14.16
[40] =>
CAD0112_01_Title
CAD0112_40_Events 26.03.12 15:27 Seite 1
I meetings _ events
International Events
2012
IDEM Singapore
20–22 April 2012
Singapore
www.idem-singapore.com
SCANDEFA
26–28 April 2012
Copenhagen, Denmark
www.scandefa.dk
ITI Congress Germany
27 & 28 April 2012
Cologne, Germany
www.iti.org
International CAMLOG Congress
3–5 May 2012
Lucerne, Switzerland
www.camlogfoundation.org
CAD/CAM & Computerized Dentistry
International Conference
3 & 4 May 2012
Dubai, UAE
www.cappmea.com
Astra Tech World Congress
9–12 May 2012
Gothenburg, Sweden
www.astratechworldcongress.com
Nobel Biocare Symposium 2012
1–2 June 2012
Avignon, France
www.nobelbiocare.com
IADR General Session & Exhibition
20–23 June 2012
Iguaçu Falls, Brazil
www.iadr.org
IACA
26–28 July 2012
Hollywood, FL, USA
www.theiaca.com
FDI Annual World Dental Congress
29 August–1 September 2012
Hong Kong, China
www.fdiworldental.org
AAID Annual Meeting
3–6 October 2012
Washington, DC, USA
www.aaid-implant.org
CAD/CAM & Computerized Dentistry
International Conference
6 & 7 October 2012
Singapore
www.cappmea.com
EAO
10–13 October 2012
Copenhagen, Denmark
www.eao.org/eao-congress
Greater New York Dental Meeting
23–28 November 2012
New York, NY, USA
www.gnydm.com
40 I CAD/CAM
1_ 2012
[41] =>
CAD0112_01_Title
CAD0112_41_Submission 26.03.12 14:58 Seite 1
about the publisher _ submission guidelines
submission guidelines:
Please note that all the textual components of your submission
must be combined into one MS Word document. Please do not
submit multiple files for each of these items:
_the complete article;
_all the image (tables, charts, photographs, etc.) captions;
_the complete list of sources consulted; and
_the author or contact information (biographical sketch, mailing
address, e-mail address, etc.).
I
Image requirements
Please number images consecutively throughout the article
by using a new number for each image. If it is imperative that
certain images are grouped together, then use lowercase letters
to designate these in a group (for example, 2a, 2b, 2c).
Please place image references in your article wherever they
are appropriate, whether in the middle or at the end of a sentence.
If you do not directly refer to the image, place the reference
at the end of the sentence to which it relates enclosed within
brackets and before the period.
In addition, please note:
In addition, images must not be embedded into the MS Word
document. All images must be submitted separately, and details
about such submission follow below under image requirements.
Text length
Article lengths can vary greatly—from 1,500 to 5,500 words—
depending on the subject matter. Our approach is that if you
need more or less words to do the topic justice, then please make
the article as long or as short as necessary.
We can run an unusually long article in multiple parts, but this
usually entails a topic for which each part can stand alone because it contains so much information.
In short, we do not want to limit you in terms of article length,
so please use the word count above as a general guideline and if
you have specific questions, please do not hesitate to contact us.
Text formatting
We also ask that you forego any special formatting beyond the
use of italics and boldface. If you would like to emphasise certain
words within the text, please only use italics (do not use underlining or a larger font size). Boldface is reserved for article headers.
Please do not use underlining.
Please use single spacing and make sure that the text is left justified. Please do not centre text on the page. Do not indent paragraphs, rather place a blank line between paragraphs. Please do
not add tab stops.
_We require images in TIF or JPEG format.
_These images must be no smaller than 6 x 6 cm in size at 300 DPI.
_These image files must be no smaller than 80 KB in size (or they
will print the size of a postage stamp!).
Larger image files are always better, and those approximately
the size of 1 MB are best. Thus, do not size large image files down
to meet our requirements but send us the largest files available.
(The larger the starting image is in terms of bytes, the more leeway the designer has for resizing the image in order to fill up more
space should there be room available.)
Also, please remember that images must not be embedded into
the body of the article submitted. Images must be submitted
separately to the textual submission.
You may submit images via e-mail, via our FTP server or post
a CD containing your images directly to us (please contact us
for the mailing address, as this will depend upon the country from
which you will be mailing).
Please also send us a head shot of yourself that is in accordance
with the requirements stated above so that it can be printed with
your article.
Abstracts
An abstract of your article is not required.
Should you require a special layout, please let the word processing
programme you are using help you do this formatting automatically. Similarly, should you need to make a list, or add footnotes
or endnotes, please let the word processing programme do it for
you automatically. There are menus in every programme that will
enable you to do so. The fact is that no matter how carefully done,
errors can creep in when you try to number footnotes yourself.
Author or contact information
The author’s contact information and a head shot of the author
are included at the end of every article. Please note the exact
information you would like to appear in this section and format it according to the requirements stated above. A short
biographical sketch may precede the contact information
if you provide us with the necessary information (60 words
or less).
Any formatting contrary to stated above will require us to remove
such formatting before layout, which is very time-consuming.
Please consider this when formatting your document.
Questions?
Magda Wojtkiewicz (Managing Editor)
m.wojtkiewicz@dental-tribune.com
CAD/CAM
1_ 2012
I 41
[42] =>
CAD0112_01_Title
CAD0112_42_Impressum 26.03.12 14:58 Seite 1
I about the publisher _ imprint
CAD/CAM
digital dentistry
international magazine of
Publisher
Torsten R. Oemus
t.oemus@dental-tribune.com
International Media Sales
Matthias Diessner
m.diessner@dental-tribune.com
Managing Editor
Magda Wojtkiewicz
m.wojtkiewicz@dental-tribune.com
Europe
Vera Baptist
v.baptist@dental-tribune.com
Product Manager
Vera Baptist
v.baptist@dental-tribune.com
Executive Producer
Gernot Meyer
g.meyer@dental-tribune.com
Designer
Franziska Dachsel
f.dachsel@dental-tribune.com
Copy Editors
Sabrina Raaff
Hans Motschmann
International Administration
Marketing & Sales
Nadine Parczyk
n.parczyk@dental-tribune.com
Executive Vice President
Finance
Dan Wunderlich
d.wunderlich@dental-tribune.com
Editorial Board
Prof Albert Mehl, Switzerland
Prof Gerwin Arnetzl, Austria
Dr Stefan Holst, Germany
Hans Geiselhöringer, Germany
Dr Ansgar Cheng, Singapore
Asia Pacific
Peter Witteczek
p.witteczek@dental-tribune.com
The Americas
Jan M. Agostaro
j.agostaro@dental-tribune.com
International Offices
Europe
Dental Tribune International GmbH
Contact: Nadine Parczyk
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 4 84 74 302
Fax: +49 341 4 84 74 173
Asia Pacific
Dental Tribune Asia Pacific Ltd.
Contact: Tony Lo
Room A, 26/F, 389 King’s Road
North Point, Hong Kong
Tel.: +852 3113 6177
Fax: +852 3113 6199
The Americas
Dental Tribune America, LLC
Contact: Anna Wlodarczyk
116 West 23rd Street, Suite 500
NY 10011, New York, USA
Tel.: +1 212 244 7181
Fax: +1 212 244 7185
Printed by
Löhnert Druck
Handelsstraße 12
04420 Markranstädt, Germany
www.dental-tribune.com
Copyright Regulations
_CAD/CAM international magazine of digital dentistry is published by Dental Tribune Asia Pacific Ltd. and will appear in 2012 with four issues. The magazine and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inadmissible and
liable to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, represent
the opinion of the afore-mentioned, and do not have to comply with the views of Dental Tribune Asia Pacific Ltd. Responsibility for such articles shall be borne
by the author. Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility
shall be assumed for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply, legal venue is North Point, Hong Kong.
42 I CAD/CAM
1_ 2012
[43] =>
CAD0112_01_Title
THE WORLD SPEAKS e.max.
*
10 YEARS OF CLINICAL EVIDENCE.*
96.8 % SUCCESS RATE.*
40 MILLION RESTORATIONS.**
1 PROVEN SYSTEM:
IPS e.max
** Based on sales.
From left: G. Ubassy, Dental Technician, France | M. Roberts, Dental Technician, USA | M. Temperani, Dental Technician, Italy | D. Hornbrook, Dentist, USA |
O. Brix, Dental Technician, Germany | U. Brodbeck, Dentist, Switzerland | G. Gürel, Dentist, Turkey | C. Coachman, Dentist, Ceramist, Brazil |
A. Shepperson, Dentist, New Zealand | A. Bruguera, Dental Technician, Spain | S. Kataoka, Dental Technician, Japan | S. Kina, Dentist, Brazil
SO DOES THE SCIENCE.
mic
a
r
e
c
l
al
eed
n
u
o
all y
* The IPS e.max Scientific Report Vol. 01 (2001 – 2011) is
now available at: www.ivoclarvivadent.com/science_e
www.ivoclarvivadent.com
Ivoclar Vivadent AG
Bendererstr. 2 | FL-9494 Schaan | Liechtenstein | Tel.: +423 / 235 35 35 | Fax: +423 / 235 33 60
HPD[BVFLHQWLILFBBHB$LQGG
[44] =>
CAD0112_01_Title
Technology designed the way you work
Great new features
Dental System™ 2012 - the future proof solution
Model Builder
Create lab models directly from
TRIOS® and 3rd party intraoral
scans. Support for implant models.
TRIOS ® integration
Receive TRIOS ® digital impressions instantly from
dentists and start designing right away.
3Shape Communicate™
Upload 3D design visualizations with a single click.
Share and discuss your cases with dentists.
2nd Generation Removable Partial Design
Intuitively mimics the familiar workƃow while
signiƂcantly reducing production time.
Digital Temporaries
Create cost-effective temporaries without pouring
a model using Virtual Preparation and Virtual
Gingiva.
D800 3D scanner
Two 5.0 MP cameras. Scans a single-die in 25
seconds, captures texture and scans impressions.
Backing our users with technology, care and expertise
New Dynamic Virtual Articulation
Next Generation Telescopes
Like using your physical articulator.
Support for Occlusion Compass. KaVo
PROTAR®evo, Whip Mix Denar ® Mark
330, SAM® 2P, Artex® compatible and
more to come.
Full freedom for designing telescopic crowns. Support for attachment
crowns and open telescopes. Add
multiple bands, parametric attachments, and customized attachments.
Scan the QR code
& sign up for our newsletter
)
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